Tubular Orthosis for Torticollis (TOT)
CAROLE JACQUES, BSR, OT* ANDSYLVIA COTTRILL-MOSTERMAN, BSc, OT, OTR*
The TOT was designed as a method of stimulating active correction of head position to midline in infants with Congenital Muscular Torticollis. Standard polyvinylchloride (PVC) tubing and specially designed plastic components are easily fit together to form a cervical collar. A circle of soft PVC tubing is doubled and fastened behind the infant's neck. Two short, upright struts span between the tubing and are positioned one below and one behind the ear on the affected side. The collar is lightweight and comfortable. It is easily fabricated and fit in a half hour. Infants receive standard treatment of stretching of the right sternocleidomastoid muscle. At approximately 4 months of age, when fair head control has be achieved but a consistent lateral tilt remains,. the TOT is fitted. The collar is worn consistently during the child's waking hours for a minimum of 4 months. Head posture without the collar is evaluated through a special photographic setup and collar wear is discontinued when head position is consistently less than 5 degrees from midline. Infants with Congenital Muscular Torticollis show a better midline orientation of the head when wearing the TOT.
*British Columbia's Children's Hospital, 4480 Oak Street, Vancouver, British Columbia V6H 3V4